Organization
WISE MIND ONLINE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRAVIS REED STEPHENS LCSW (OWNER)
(208) 243-3332
Entity
Organization
Contact information
Practice address
16252 E 3RD ST, BAYVIEW, ID 83803-8002
(208) 243-3332
Mailing address
16252 E 3RD ST, BAYVIEW, ID 83803-8002
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
12/28/2022
Last updated
12/28/2022
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